Fetal Alcohol Syndrome Disorders (FASD) are diagnosed and divided into Fetal Alcohol Syndrome (FAS), Partial FAS (PFAS), Static Encephalopathy Alcohol Exposed (SE/AE) and Neurobehavioral Disorder Alcohol Exposed (ND/AE) according to a 4-Digit Diagnostic Code which is used worldwide (http://depts.washington.edu/fasdpn). There are no guidelines for examination of the eye and the visual pathways in individuals with prenatal alcohol exposure. We tested the hypothesis that the more severe FASD the more ophthalmological abnormalities are found. Our purpose was also to develop and evaluate an ophthalmological tool serving as a complement to the method described above which evaluating growth, central nervous system functions, developmental delay and behavioral dysfunction as well as face characteristics in FASD.

Methods

Fifty children with a mean age of 7.6 years (range 4.9 to 10.4) were evaluated; 25 children (13 M, 12 F) with FASD and 25 age and sex matched controls. The four ophthalmological digits used were: Visual acuity (VA), refraction, strabismus/binocular function and structural abnormalities of the eye (Fig.). The magnitude of expression of each feature is ranked independently on a 4-point Likert scale with 1 reflecting normal ophthalmological findings and 4 reflecting a strong presence of the most common ophthalmological abnormalities found in our children with FASD. Thus, code 4444 reflects the most severe expression of reduced VA, significant refractive errors, manifest strabismus/defect binocular functions and structural abnormalities of the eye. At the opposite end of the scale code 1111 reflecting normal ophthalmological findings.

Our results are in consistence with our hypothesis that children with fully developed FAS have the highest score of ophthalmological abnormalities. This tool, the 4-Digit Eye Diagnostic Code, which is based on the most common ophthalmological abnormalities found in these children, may serve as an diagnostic help and further developed a guideline for what and when children with FASD should be examined and followed-up.